Living Donor Liver Transplant Program Expands Access for Pediatric and Complex Liver Disease Patients

Liver transplantation in the United States continues to be constrained by limited donor organ availability, particularly for pediatric patients.

In response, AdventHealth Orlando has spent the past three years assembling the surgical expertise, advanced imaging capabilities and multidisciplinary transplant infrastructure necessary to establish a living donor liver transplant (LDLT) program under the direction of transplant surgeon and surgical oncologist Ryan W. Day, MD. Living donation provides greater flexibility in transplant timing and expands options for patients who may not receive timely access through the deceased donor system.

LDLT is a life-saving procedure in which a segment of a healthy individual’s liver is surgically removed and transplanted into a patient with end-stage liver disease or cancer. With the liver’s regenerative capacity, the donor’s remnant liver typically restores to near-normal volume within weeks, while the transplanted graft grows in the recipient to meet metabolic and functional demands.

AdventHealth Orlando performed its first LDLT surgery with a pediatric recipient on January 14, 2026, and the first LDLT for an adult recipient was performed on February 18, 2026. In the pediatric case, 23-year-old law student Sophie Byroade donated a portion of her liver to Nolan Smith, a 4-year-old suffering from biliary atresia, a rare, progressive, congenital condition where the bile ducts form abnormally, negatively impacting the liver’s function.

“I’m happy to report that in both cases, the donor and recipient are doing well,” shares Dr. Day. “Living donor liver transplant is one of the most complicated operations performed anywhere in the world, and we safely completed it. Having this new capability is going to save additional lives, allowing us to transplant more children as well as adults with difficult diseases who are underrepresented in the deceased donor system such as cancer patients with colorectal liver metastases, hepatocellular carcinoma, and cholangiocarcinoma.”

A Critical Step to Address a Growing Need

As of December 1, 2025, 9,022 individuals were listed nationally on the waiting list for deceased donor liver transplantation according to official Organ Procurement & Transplantation Network (OPTN) data. The wait time for pediatric patients has increased since 2023, and the transplants per waitlist mortality ratio, which compares how many transplants occur to how many people die while waiting for a transplant, has been rising in recent years for both adult and pediatric patients.

Liver allocation is primarily determined by a patient’s severity of illness as measured by the Model for End-Stage Liver Disease (MELD 3.0) and Pediatric End-Stage Liver Disease (PELD) scores, with higher scores receiving priority. Living donor liver transplantation allows patients to receive a transplant before reaching critical illness, regardless of their MELD or PELD score, which can substantially reduce the wait time.

“We’ve noticed over the past few years, that it has been more difficult to find livers for our patients,” comments AdventHealth transplant surgeon Thomas Chin, MD. “The people who are getting the good quality livers the quickest are the very sick patients, putting medium to high MELD and PELD patients at a disadvantage. Living donor is a way of getting them a liver before they get too sick. It really is the final piece of offering everything possible to get our patients transplanted.”

Developing the LDLT program required extensive planning to assemble and train the surgical and multidisciplinary care teams, develop proper protocols and secure the advanced imaging equipment necessary to conduct 3D mapping of the liver. AdventHealth received its provisional approval from the United Network for Organ Sharing (UNOS) in 2025. The program aims to perform 10 to 12 living donor liver transplants per year within the next couple of years. AdventHealth for Children has the only pediatric liver transplant program in Central Florida, and it’s strengthened through a collaboration with UPMC Children’s Hospital of Pittsburgh established in 2018.

Improving Patient Outcomes Through Living Liver Transplantation

In addition to decreasing wait times and increasing the overall organ supply, key benefits of LDLT include the following:

• It is a planned, elective procedure. Because of this, the cold ischemia time – the period when the liver is outside the body without perfusion – is minimized.
• Livers from living donors are typically of excellent quality, as donors undergo thorough medical evaluations and are approved only if they are in outstanding health.
• Overall long-term outcomes are improved. In a systemic review and meta-analysis comparing outcomes for pediatric LDLT and deceased donor liver transplantation (DDLT), LDLT resulted in superior patient survival at 1, 3 and 5 years post-transplant and was also associated with lower rates of rejection. A separate, similar study came to the same conclusion and reported up to 10-year data on patient and graft survival outcomes.

“Now, with our living liver program, we can transplant patients before they have any significant clinical deterioration,” comments AdventHealth for Children Medical Director of Pediatric Advanced Hepatology and Liver Transplantation Dellys Soler Rodriguez, MD. “This is a huge win in terms of improving outcomes. Plus, families no longer need to leave the state to be offered this opportunity.”

In addition to better serving pediatric patients with liver disease, Dr. Day is excited about how the living liver transplant program will expand the transplant oncology capabilities at AdventHealth. He performed Central Florida’s first liver transplant for unresectable colorectal liver metastases with a deceased donor liver last fall.

“For some cancer patients, liver transplantation offers the best chance of long-term survival or cure,” states Dr. Day. “However, these patients don’t receive high priority for deceased donor transplants even though there’s obviously a ticking clock for them because they have cancer that can potentially metastasize. Living donor liver transplant can be a great option.”

Delivering Personalized Care

As AdventHealth looks to grow its new living donor liver transplant program, Dr. Day emphasizes the importance of continuing to provide personalized, whole-person care.

“We’ve been intentional about building a program that offers the full spectrum of liver transplant care,” he points out. “Having these capabilities under one roof gives our patients the greatest possible opportunity to receive a transplant and a new lease on life. But transplantation is never one-size-fits-all. I often compare it to the work of a master artist: you need different brushes, colors and textures to create the right result. In the same way, every patient’s journey is unique, and we tailor our approach accordingly. Above all, our commitment is to safety, to thoughtful decision-making and to helping our patients feel whole again.”

Ensuring Donor Safety

While many living liver donors are a relative of the patient, they don’t have to be. Increasingly, there are even people who choose to donate altruistically without having a recipient in mind as in Sophie’s and Nolan’s case. Regardless, all donors are thoroughly evaluated, and donor safety is the highest priority. AdventHealth’s independent living donor advocate educates all potential donors and is required to assess each to ensure they understand the pros and cons of their decision and that they are making this choice without coercion.

Basic criteria for live donation of a liver include the following:

• Must be between the ages of 18 and 60
• Must be in excellent physical and mental health, including:
  • No significant heart, lung or kidney disease
  • No uncontrolled high blood pressure or diabetes
  • No active infections
  • No history of liver disease such as hepatitis or cirrhosis
• Must have a compatible blood type with the recipient
• Must have a body mass index (BMI) that is less than 32
• No active substance abuse

Anyone interested in becoming a donor for the living liver program can visit Donating a Liver | AdventHealth Transplant Institute to learn more.